A 45-year-old woman complains of leaking urine when she coughs, sneezes, or laughs. There is no urgency or frequency. Urodynamic study shows a leak point pressure of 65 cmH2O with no detrusor overactivity. Which of the following surgical options provides the HIGHEST long-term success rate?

• A Anterior colporrhaphy (anterior repair)
• B Burch colposuspension
• C Periurethral bulking injections
• D Mid-urethral sling (tension-free vaginal tape, TVT) ✓

Explanation

Mid-urethral slings (TVT — tension-free vaginal tape, or TOT — transobturator tape) are the current gold-standard surgical treatment for stress urinary incontinence with success rates of 85–95% at 5 years. They provide dynamic urethral support without excessive tension. Burch colposuspension was the previous standard but is more invasive with similar long-term outcomes. Anterior colporrhaphy has cure rates <50% for SUI and is not recommended as primary SUI surgery. Bulking agents have lowest durability.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.